Editorial

December 2015Carolyn L. WesthoffIn this month's issue of Contraception, we publish 11 original research articles and 1 review paper about contraceptive implants and intrauterine devices (IUDs). This extraordinary number of papers regarding long-acting reversible contraception (LARC) methods is an accurate reflection of the increasing interest in using highly effective and long-acting methods. Read abstractLogin to read full article

Review

Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic reviewRebecca Callahan, Irina Yacobson, Vera Halpern, Kavita NandaObjective: Use of contraception lowers a woman's risk of experiencing an ectopic pregnancy. In the case of method failure, however, progestin-only contraceptives may be more likely to result in ectopic pregnancies than some other methods such as combined hormonal and barrier contraceptives.Conclusion: Progestin-only contraceptive implants and injectables protect against ectopic pregnancy by being highly effective in preventing pregnancy overall; however, the absolute risk of ectopic pregnancy varies by type of progestin. Risk of ectopic pregnancy should not be a deterrent for use or provision of these methods.Read abstractLogin to read full article

Six-month and 1-year continuation rates following postpartum insertion of implants and intrauterine devicesIrene Woo, Sara Seifert, Dacia Hendricks, Roxanne M. Jamshidi, Anne E. Burke, Michelle C. FoxObjective: Studies show immediate postpartum (PP) insertion increases use of contraceptive implants and intrauterine devices (IUDs). Our objective was to compare the satisfaction and continuation rates of the two types of devices at 6 months and 1 year following PP insertion.Conclusions: Placement of implants and IUDs immediately PP can lead to high satisfaction. Despite early IUD expulsions, continuation rates were similar to those placed outside of the immediate PP period.Read abstractLogin to read full article

Projections and opinions from 100 experts in long-acting reversible contraceptionDiana Greene Foster, Rana Barar, Heather Gould, Ivette Gomez, Debbie Nguyen, M. Antonia BiggsObjective: This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods.Implications: Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women’s reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.Read abstractLogin to read full article

Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortionJody E. Steinauer, Ushma D. Upadhyay, Abby Sokoloff, Cynthia C. Harper, Justin T. Diedrich, Eleanor A. DreyObjective:Women who have abortions are at high risk of contraception discontinuation and subsequent unintended pregnancy. The objective of this analysis was to identify factors associated with choice of highly effective, long-acting, progestin-only contraceptive methods after abortion.Implications: In contraceptive counseling, after screening for IPV, assessing patient’s stress and taking a history about past contraceptive use, clinicians should discuss whether these factors might affect a patient’s choice of method.Read abstractLogin to read full article

Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trialNora Doty, Laura MacIsaacIntroduction:Intrauterine devices (IUDs) are used by only 5.6% of contraceptive users in the United States. One barrier to IUD uptake is fear of pain during insertion, particularly among nulliparous women. Many interventions to reduce pain during IUD insertion have proven unsuccessful. Comparisons of different tenaculae have not been previously reported.Conclusion: This is the first randomized trial comparing tenaculae. There was no difference in reported pain, but the vulsellum may be associated with less bleeding than a single-tooth tenaculum. Women with higher preprocedure anxiety may experience more pain during IUD insertion. Future research could investigate an anxiolytic's effect on pain during IUD insertion.Read abstractLogin to read full article

Controlled release of copper from an intrauterine device using a biodegradable polymerReshmi Ramakrishnan, Bharaniraja B, Abi Santhosh ApremBackground: The adverse effects of copper intrauterine devices (IUDs) such as abnormal bleeding, pain and cramps may be due in part to the burst release of copper ions during the first few months of usage. This study focuses on controlling the initial burst release of copper ions.Conclusion: Coating a CuT380 IUD with biodegradable polymer reduced the initial copper release without affecting release at 1 year. Clinical trials are required to determine whether this could reduce side effects such as bleeding and pain associated with copper containing IUDs.Read abstractLogin to read full article

Unintended pregnancy among active-duty women in the United States military, 2011Kate Grindlay, Daniel GrossmanObjectives: To estimate unintended pregnancy rates among a representative sample of active-duty women in the U.S. military aged 18–44 years in 2011.Implications: Unintended pregnancy is high in the military, including during deployment; further efforts to improve evidence-based provision of contraception and education are needed.Read abstractLogin to read full article

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